Diamedica Draw-over Vaporiser: bench testing the UK Defence Anaesthesia System in the deployed environment

Abstract

IntroductionThe Diamedica Draw-over Vaporiser 2 (DDV2) is the sevoflurane vaporiser used by the UK Defence Medical Services to provide deployed volatile general anaesthesia. The Defence Anaesthesia System employs the DDV2 with a turbine-driven ventilator as a ‘push-over’ vaporiser, a modification from the manufacturer’s design. We investigated sevoflurane delivery at varying minute volumes (MVs), vaporiser settings and temperatures in this configuration.MethodsA range of DDV2 settings (1%, 2%, 3%, 4% and induction) and MVs (2, 4, 6 and 8 L/min at 12 ventilations per minute) were tested at two ambient temperatures (20 and 30±3°C) over 30 min. A supplemental experiment, simulating anaesthesia during damage control surgery, was also completed, where he DDV2 was set to 2% with a 6 L/min MV for 90 min.ResultsIn both experiments, two distinct phases of sevoflurane delivery were noted, a ‘wash-in phase’ followed by a ‘maintenance period’. The wash-in phase normally lasted less than 5 min. During the maintenance period at low MVs and vaporiser settings the DDV2 delivered a constant output, while at higher MVs and settings vapour output fell predictably. At 20±3°C, using DDV2 settings likely to be encountered in clinical practice, sevoflurane delivery was within 20% of that set. Higher vaporiser settings, MVs and temperatures resulted in greater variation between vaporiser setting and agent delivery. This variation is explained by the incomplete temperature compensation of the DDV2.ConclusionsThe DDV2 functions predictably at a range of settings, MVs and temperatures. Anaesthetic delivery in the defence anaesthesia configuration is like that previously described in the draw-over configuration. The equipment was found to be reliable and robust. This experimental work supports the continued use of the Defence Anaesthesia System for the delivery of and training in deployed general anaesthesia.